Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Wednesday, May 08, 2013

Tales of the Wayfaring Generic Manager - from Ritz Carlton Hotels to Henry Ford West Bloomfield Hospital to Cancer Treatment Centers of America

In 2006, we wondered what a former hotel manager, Mr Gerard van Grinsven, admittedly known for putting the "wow" back in the Detroit Ritz-Carlton, would be doing as a hospital CEO. This seemed at the time like a real "wow" example of how generic managers were taking over health care. Mr Grinsven had extensive experience in the hospitality field, but no known background in health care.

Over the next few years, Mr van Grinsven's Henry Ford West Bloomfield hospital did make a name for itself. In 2009, Becker's Hospital Review reported on some of Mr Van Grinsven's innovations.

First, he lead an apparent change in the hospital's mission from acute care to recreating:

the hospital experience into one focused
on promoting wellbeing and healthy living. The hospital has already
begun to realize its mission statement, which reads 'to take health and
healing beyond the boundaries of imagination.'

The new hospital apparently was designed to look like a luxury hotel:

The hospital is located on 160 acres of woodlands and is designed to
resemble a Northern Michigan lodge. The facility also features a retail
'main street' which looks like an actual main street in a Northern
Michigan town and includes stores focused on sleep, pregnancy, organic
food and healthy cooking as well as a pharmacy.

Apparently it is now a favored site for weddings:

The hospital also holds free concerts for the community and has already received nine wedding inquiries.

It had a "wellness center"

Henry Ford West Bloomfield also features a unique, integrated wellness
center called Vita. Vita offers acupuncture, therapeutic message, yoga
and relaxation classes, an aqua therapy suite, a spa and health coaches
who provide lifestyle and exercise consultations. In addition to
offering one-time services, the hospital offers memberships to community
members to encourage frequent use of the center.

What really stood out was its food service:

Henry Ford brought in top Michigan chef Matt Prentice to transform
traditional hospital food service. The hospital features 24-hour room
service for patients, all of which is served by the hospital's on-site
gourmet, organic restaurant, Henry's. All food served in the hospital is
organic, promotes sustainable agriculture and, in many cases, is
procured from local farmers.

the hospital is on track to generate millions of dollars a year hosting
and catering functions for companies and community groups.

It all sounds great, if it were describing a luxury hotel.

The Fortune article ended with the gushing summation:

While it will be years before anyone can say whether this model works,
there's no question that it captures a spirit of innovation that just
might be a cure for what ails so many organizations. We are living today
through the age of disruption. You can't do big things if you're
content with just doing things a little better than everyone else or a
little differently from how you've done them in the past. In an era of
intense competition and non-stop reinvention, the only way to stand out
from the crowd is to stand for something special. Originality has become
the acid test of strategy.

Neither it nor the Becker's rather uncritical discussions dealt with what any of this had to do with the fundamental mission of a hospital, to care for the sick, what it has to particularly do with quality of care, especially care of severely acutely or chronically ill patients, traditionally those whom hospitals were meant to serve. Would a patient desperately sick from a myocardial infarction (heart attack), stroke, sepsis (bacterial blood stream infection) or the other major ills that bring people to hospitals really care that if he or she were to survive without major sequelae, organic, locally grown food would be served in the hospital's fancy restaurant? Is there any evidence that provision of any of these fancy hotel amenities would affect important clinical outcomes for such patients? Could the funds needed for all these fancy hotel services be better spent to improve patients' the the population's health?

On to a More Ethically Challenged Environment

We may never know. But what we do know is that Mr van Grinsven, having brought "wellness" centers and organic, locally grown, gourmet food to an acute care hospital, is now moving on.

Henry Ford West Bloomfield Hospital President and
CEO Gerard van Grinsven has resigned from the position effective June 1,
according to an internal email sent Friday to employees from Henry Ford Health System President and COO Bob Riney.

Van Grinsven is leaving the hospital to become the president and CEO of Chicago-based Cancer Treatment Centers of America,
Riney said in the email. He will oversee the CTCA's five hospitals and
medical centers in Illinois, Pennsylvania, Oklahoma, Arizona and
Georgia. The CTCA is expected to announce van Grinsven's new position
later today.

Henry Ford Health System CEO Bob Riney saluted van Grinsven thus,

'Gerard's leadership talents and his tremendous global experience made
the transformation of this innovation and distinctive vision a reality,'
Riney told employees in the email.

He did not apparently mention anything about the quality of care for acutely and chronically ill patients. The press release from CTCA proclaimed

'Gerard's arrival is an exciting and dramatic step in the evolution of
our leadership that will herald new opportunities for all of our
talented Stakeholders and the thousands of patients we serve,' said
[executive chairman and former CEO Stephen B] Bonner. 'Our expertise in Patient Empowerment Medicine® and
track record implementing change is unparalleled. Nothing we do today
is the same as we did two years ago. Gerard is uniquely qualified to
provide the leadership required to advance our commitment to
patient-centered care in all we do,' concluded Bonner.

Of course, there was nothing about how van Grinsven's expertise in wellness centers and organic produce would be useful to an organization supposedly devoted to cancer patients, whose care may involve risky treatment choices and who may become desperately ill.

There was also nothing about how van Grinsven's background would help CTCA to avoid new ethical misadventures. Earlier this year, we posted about issues involving CTCA making unsubstantiated survival claims; promoting "integrative" treatments that are unsupported by evidence; and manipulating survival statistics, in part by turning away patients with poor prognoses. Of course, it is not clear that given van Grinsven's background he would even understand why such behavior is unethical.

Summary

As a physician, it is hard not to laugh at all this, at least to keep from crying. As we have noted frequently, health care has been taken over by generic hired managers. At best, while well meaning, many of them seem clueless about the nature and context of health care, and health care professionals' values. At worst, the manager's coup d'etat has turned managers into manager-kings, queens and nobles, while driving up health care costs, and sacrificing the health of patients and the public. The depth of this phenomenon is demonstrated by the absolute lack of skepticism about the worthiness of a former Ritz-Carlton executive to run either a community hospital or a system of cancer treatment centers.

I say once again that true health care reform would put in place leadership
that understands the health care context, upholds health care
professionals' values, and puts patients' and the public's health ahead
of extraneous, particularly short-term financial concerns. We need
health care governance that holds health care leaders accountable, and
ensures their transparency, integrity and honesty.

2 comments:

Interesting experiment. I applaud their desire to innovate, but agree with you that you really need leadership that understands the healthcare context and healthcare governance that holds health care leaders accountable, and ensures transparency, integrity and honesty. How do you think that Obamacare impacts true health care reform, with its provisions on readmissions penalties and DSH payment reductions?

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